Abstract

Empowering Oncology Teams: Navigating Prior Authorization Challenges to Improve Patient Care

Rifeta Kajdic Hodzic, CHPM1, Sarah Hudson-Disalle, PharmD, RPh, FACCC2, Jordan Karwedsky, FACCC3, Aimee Hoch, MSW, LSW, OSW-C, FACCC4, Angie Santiago, BBA, CRCS, FACCC5, Wendi Waugh, BS, RT(R)(T), CMD, ODS, FACCC6, Margaret Liang, MD, MSHPM7, Sarah Shaw8, Molly Kisiel, MSN, FNP-BC9, Rania Emara9, Ashley Lile, MPH10, Emily Carroll, MHA9, Elana Plotkin, CMP-HC9 and Vivian Dondlinger11
(1)Association of Cancer Care Centers (ACCC), Rockville, MD, (2)The James Cancer Hospital and Wexner Medical Center at the Ohio State University, Columbus, OH, (3)Green Bay Oncology, Green Bay, WI, (4)Grand View Health, Sellersville, PA, (5)Sidney Kimmel Cancer Center at the Thomas Jefferson University Health System, Philadelphia, PA, (6)Southern Ohio Medical Center, SOMC Cancer Center, Portsmouth, OH, (7)Cedars-Sinai Medical Center, Cedars-Sinai Cancer Center, Los Angeles, CA, (8)St. Luke's Cancer Institute, Boise, ID, (9)Association of Cancer Care Centers, Rockville, MD, (10)Rockville, NC, (11)ACCC, Milwaukee, WI

APHA 2025 Annual Meeting and Expo

Introduction:
Increasing complexity of prior authorizations has created significant barriers to care, resulting in treatment delays for patients undergoing anti-cancer therapies. Complicated insurance requirements ranked in the top 5 challenges by respondents to Association of Cancer Care Centers (ACCC) Financial Advocacy census survey in 2023. In response, ACCC launched a prior authorization initiative to support oncology teams in navigating these challenges to promote the delivery of high-quality patient care.

Objective:
This initiative aimed to demonstrate effective strategies, tips, and interventions that facilitate successful prior authorization submissions for multidisciplinary oncology professionals.

Method:
ACCC developed a six-part expert-led webinar series and tip sheets addressing critical aspects of prior authorization: medical necessity, billing and coding comprehension, and documentation requirements.

Results:
A total of 778 oncology multidisciplinary members registered for the series, with 511 (66%) participating in the live sessions. Over 1,544 views have been recorded since the webinars commenced, highlighting the need for more training. During a webinar, one participant shared, "Authorizations are complex, it's good to come together and share best practices.”

Conclusion:
The strong attendance underscores the growing burden faced by oncology providers in managing prior authorizations, which often require extensive documentation and justification to secure necessary treatments for patients. This initiative meets an urgent educational need and emphasizes the importance of public health: streamlining administrative procedures in cancer care can enhance patient outcomes and improve access to vital therapies. By gaining the necessary skills and knowledge, oncology teams can reduce treatment delays and advance health equity in cancer care.

Administration, management, leadership Advocacy for health and health education Communication and informatics Implementation of health education strategies, interventions and programs Public health or related laws, regulations, standards, or guidelines Public health or related organizational policy, standards, or other guidelines